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80 Chapter 3 TABLE 2. Prevalence of functional defecation disorders in obese children Author,year Country, setting Population Controls Definition OW/OB and its measurement Definition FC and its measurement n (%) FC n (%) FI Conclusion Comments Fishman et al . 2004 USA, prospective observational study at obesity clinic Tertiary care center n=80 1-18 years ♂ : 39% n/a OW: n/a OB: BMI > 95 th percentile Weight and height measurements Not reported which reference values were used 2 or more of the following, ≥25% of the time, ≥3 months: hard or pellet-like stools, infrequent stools (less than 3 per week), straining, painful defecation, or sense of incomplete evacuation. Soiling was defined as presence of fecal material in underwear or pajamas in a child older than 48 months of age for at least 3 months Assessed with standardized questionnaire 18/80 (23%) Total: 12/80 (15%) -FNRFI a : 6/80 (8%) FC: 6/18 (33%) Prevalence of FC in OB children (23%) higher than previous reports (3-16%) BMI adjusted for age and gender, not reported which reference values were used Discrepancy number of males: 30 according to text and 31 according to table) Van der Baan– Slootweg et al . 2011 The Netherlands, prospective observational study at obesity clinic Tertiary care center n=91 8-18 years ♂ : 34% n/a OW: n/a OB: BMI ≥35, or BMI ≥30 in the presence of obesity-related morbidity Methods of anthropometric data collection not reported Reference values based on the International Obesity Task Force: to obtain the curve corresponding to an adult BMI of 35, the difference of the distance of the 25 and 30 curves was added to the 30 curve Rome III criteria Assessed with standardized questionnaire 19/91 (21%) Total: 5/91 (5%) -FNRFI a : 1/91 (1%) FC: 4/19 (21%) Higher frequency of FC in children with obesity (21%) compared to worldwide prevalence (8.9%) C, control group; FI, fecal incontinence; NA, not applicable; OB, obesity; OW, overweight. a FI in children who did not fulfill the criteria for FC was considered FNRFI